New Orleans, La. From the Center for Restorative Breast Surgery.
Plast Reconstr Surg. 2012 Mar;129(3):551-561. doi: 10.1097/PRS.0b013e31824127fc.
Advances in autologous breast reconstruction continue to mount and have been fueled most substantially with refinement of perforator flap techniques.
For patients with a desire for autogenous breast reconstruction and insufficient abdominal fat for conventional abdominal flaps, secondary options such as gluteal perforator flaps or latissimus flaps are usually considered. Patients who also have insufficient soft tissue in the gluteal donor site and preference to avoid an implant, present a vexing problem. The authors describe an option that allows for incorporation of four independent perforator flaps for bilateral breast reconstruction when individual donor sites are too thin to provide necessary volume. The authors present their experience with this technique in 25 patients with 100 individual flaps over 5 years.
The body lift perforator flap technique, using a layered deep inferior epigastric perforator/gluteal perforator flap combination for each breast, was performed in this patient set with high success rates and quality aesthetic outcomes over several years. Patient satisfaction was high among the studied population.
The body lift perforator flap breast reconstruction technique can be a reliable, safe, but technically demanding solution for patients seeking autogenous breast reconstruction with otherwise inadequate individual fatty donor sites. This sophisticated procedure overcomes a limitation of autogenous breast reconstruction for these patients that otherwise results in a breast with poor projection and overall volume insufficiency. The harvest of truncal fat with a circumferential body lift design gives the potential added benefit of improved body contour as a complement to this powerful breast reconstructive technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
自体乳房重建技术不断进步，主要得益于穿支皮瓣技术的改进。
对于希望进行自体乳房重建但腹部脂肪不足无法进行传统腹部皮瓣的患者，通常会考虑臀上穿支皮瓣或背阔肌皮瓣等次要选择。对于那些臀部供区软组织也不足且希望避免使用植入物的患者，这是一个令人烦恼的问题。作者描述了一种选择，即当单个供区太窄无法提供必要的体积时，可以使用四个独立的穿支皮瓣进行双侧乳房重建。作者在 5 年内对 25 名患者的 100 个独立皮瓣使用该技术的经验进行了介绍。
使用分层的腹壁下动脉穿支/臀上穿支皮瓣组合，为每侧乳房进行体雕穿支皮瓣技术，在这组患者中取得了较高的成功率和多年来优质的美学效果。研究人群的患者满意度很高。
对于寻求自体乳房重建但单个脂肪供区不足的患者，体雕穿支皮瓣乳房重建技术是一种可靠、安全但技术要求较高的解决方案。对于这些患者，这种复杂的手术克服了自体乳房重建的一个局限性，否则会导致乳房突出度差和整体体积不足。采用环形体雕设计采集躯干脂肪，可能会带来更好的身体轮廓改善，这是对这种强大的乳房重建技术的补充。
临床问题/证据水平：治疗，IV。
